title: The structure of service quality perceptions for multiple-encounter services.
abstract: OBJECTIVE
  The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively.
  
  
  METHODS
  In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage.
  
  
  METHODS
  Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs).
  
  
  RESULTS
  Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs.
  
  
  CONCLUSIONS
  Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.
mesh_terms: D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008962:Models, Theoretical; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011787:Quality of Health Care